Milligan Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulated both the premises and the care provided, and both were looked at during this inspection.

Milligan Road accommodates up to ten people in one adapted building. At the time of the inspection there were nine people in residence, of which two people were in hospital. Milligan Road supports people with a diagnosed mental health need, learning disability and whose behaviour can be challenging. Some people also have Autism.

This inspection took place on 7 February 2019 and was unannounced. We returned, announced on 8 February 2019.

Milligan Road had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Milligan Road was previously inspected by the Care Quality Commission on 24 and 26 May 2017 and was rated good. This inspection found the key question is the service safe to have been revised to good. The service did not retain the rating of good to the key question is the service well-led and was found to require improvement.

The overall rating following this inspection remains good.

The provider had recently appointed a head of operations for adult services who had taken over the role of registered person. The registered person had undertaken a range of audits in key areas for the purposes of monitoring the quality of the service. The audits undertaken had identified key areas of improvement were required and an action plan had been developed by the registered person. As with the registered manager, a registered person has a legal responsibility to meet the requirements in the Health and Social Care Act 2008.

Improvements identified including the decorating and replacing of floor coverings in communal areas of the service. The work to bring about improvement had started.

Opportunities to learn from accidents and incidents to improve the support people received were not fully utilised. Some staff had not completed or renewed their training in key areas to promote people’s welfare.

People’s views and that of family members were sought through meetings and the completion of surveys. People’s comments were not always followed through to ensure they received a response to requests they had made.

We found one area in which people were not fully supported to have maximum choice and control of their lives. The registered person and registered manager said they would review the restriction placed on people’s access to the kitchen. People’s capacity to make informed decisions had been assessed. Referrals had been made to relevant organisations to deprive people of their liberty which complied with the Mental Capacity Act.

People’s safety was promoted. People received their medicine as prescribed. We recommended that the provider access good practice guidance in relation to use of medicine for people with a learning disability and or autism.

People accessed a range of health care services with the support of staff. Staff and people using the service worked together to improve and maintain the health of people. People’s dietary needs, including specialist diets were catered for.

People were supported by sufficient and skilled staff to meet their individual needs. Potential risks to people were assessed and information as to how to reduce the risk were in place. This covered a wide range of topics to ensure people’s needs were met safely. Risk assessments were understood and implemented by staff.

Staff had a good understanding of people’s needs and had developed positive relationships with people which meant they were able to respond when people became u

The inspection visit took place on 24 May and 26 May 2017. The visit was unannounced.

244 Milligan Road is a residential home which provides care to people with learning difficulties who also have mental health needs. It is registered to provide care for up to 10 people. At the time of our inspection there were 10 people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People using the service and relatives we spoke with said they thought the home was safe. Staffing levels were sufficient to ensure people's safety. Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

Staff were subject to checks to ensure they were appropriate to work with the people who used the service, but these had not been comprehensively followed up when issues of possible concern had been noted. People's risk assessments provided staff with information on how to support people safely, though some assessments were not in place.

People using the service told us they thought their medicines were given safely and on time.

Staff had been trained, in the main, to ensure they had the skills and knowledge to meet people's needs. Staff understood their main responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives.

People had plenty to eat and drink and everyone told us they liked the food served. People's health care needs were met by referrals to health care professionals when necessary.

People told us they liked the staff and got on well with them. We saw many examples of staff working with people in a friendly and caring way. People and their representatives were involved in making decisions about their care, treatment and support.

Care plans were individual to the people using the service and covered their health and social care needs. Activities were organised to provide stimulation for people and they took part in activities in the community if they chose.

People and their relatives told us they would tell staff if they had any concerns and were confident these would be followed up.

People, staff and most relatives we spoke with were satisfied with how the home was run by the registered manager. Management carried out audits and checks to ensure the home was running properly to meet people's needs, though not all essential areas had been audited.

This inspection took place on 16 June 2015 and was unannounced.

Milligan Road is registered to provide residential care and support for 10 people with a learning disability, some of whom are living with dementia. At the time of our inspection there were 6 people using the service.

The service is a converted residential property which provides accommodation over two floors. The service is located within a residential area and has an accessible courtyard to the rear of the property.

Milligan Road had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were confident that if they had any concerns about people’s safety, health or welfare then they would know what action to take, which would include reporting their concerns to the registered manager or to external agencies. Staff had received training which reflected the needs of people who used the service and enabled them to provide care in a safe manner. This included supporting people with the specific health related conditions and the appropriate use of equipment to move people safely.

We found people received their medication in a timely and safe manner by staff that had been trained in the administration of medication. We saw people accessing a range of community activities with the support of staff. People’s needs had been risk assessed to promote their safety. We saw there were sufficient staff to support people’s individual needs.

People were protected under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that appropriate referrals had been made where people were thought to not have capacity to make certain decisions and had restrictions placed upon them.

People’s health and welfare was promoted and they were referred to relevant health care professionals in a timely manner to meet their health needs.

The attitude of the registered manager and staff showed they were enthusiastic about their work and committed to providing the best possible care for all those who used the service. All were aware of each person’s individual needs. Staff appeared caring, friendly and talked about their work and were well informed about those using the service.

People using the service appeared well cared for and were content and there appeared to be a happy atmosphere within the service. The service had the atmosphere of a homely, large house and was decorated and furnished to reflect this.

There were effective systems in place for the maintenance of the building and equipment which ensured people lived in an environment that was well maintained and safe. Audits and checks were effectively used to ensure people’s safety and needs were being met, as well as improvements being made as required. People using the service and staff had the opportunity to influence the service by attending meetings and sharing their views, which enabled the provider to review and develop the service.